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Medicare Blog | Medicare News | Medicare Information

Closing the gap on the 'Doughnut Hole'

Posted by Guadalupe Cantu on Fri, Oct 11, 2013 @ 11:43 AM

Medicare Supplements The Affordable Care Act rollout last week was not all smooth sailing. It faced multitudes of glitches and hiccups online; as well as, offline. Despite its rocky start, the Affordable Care Act aims to reduce the Medicare coverage gap, also known as the "doughnut hole," by 2014 and completely close it by 2020, according to Medicare.gov.

Before the Affordable Care Act, benefactors would have to pay their insurance yearly deductible in out-of-pocket cost until their medical expense limit reached the copay of $4500.00, before any coverage premiums would kick in.

In 2014, with the Affordable Care Act, beneficiaries begin with the monthly Part D premiums and pays 100% of the drug cost until satisfying the $310 deductible. Then the plan pays for the rest of the cost of the medicine until hitting the expenses cap of $2850.00; a 25% out-of-pocket drop in copay. That’s when seniors are faced with the doughnut hole, once more.

The dreaded “doughnut hole” – is the difference seniors out-of-pocket drug expenses begins, after their Part D premiums coverage cap has been exceeded, and before they are eligible for the amount the government pays for "catastrophic" drug coverage.

Since 2010, the Medicare gap has been slowly closing through steady drug discounts. This is largely due to the government reaching out to pharmaceutical industry and bargaining for drug discounts. Discounts for brand name drugs and generic will continue. By next year, were expected to pay 47.5% for premium brand pharmaceuticals names and 72% for generic ones.

By 2020, Medicare Part D enrollees will save 75% on both premium and generic medication, according to the Centers for Medicare & Medicaid Service.


Please give us your feedback!
Is the ACA program better than what we had before? Do you think it will truly make Insurance more competitive and affordable?

 

Source: LifeHealthPro & Centers for Medicare & Medicaid Service

Additional Updates:
    • 2014 Medicare Advantage and Part D Certifications are now available! Learn More

Tags: Obamacare, Doughnut Hole, Part D Premiums, Medicare, Affordable Care Act, Affordable Care

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